Endoscopic ultrasound-guided fine-needle biopsy in patients with unexplained diffuse gastrointestinal wall thickening

Abstract

Background and study aims Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is recommended after non-diagnostic biopsy in gastrointestinal wall thickening, although the performance of currently available FNB needles in this setting is unknown. We aimed to assess the diagnostic accuracy and safety of EUS-FNB and to evaluate the "T" wall staging in malignant pathology. Patients and methods This was a single center retrospective study that included all consecutive patients undergoing EUS-FNB for diffuse gastrointestinal wall thickening with at least one previous negative conventional endoscopic biopsy between January 2016 and November 2019. EUS-FNB was performed using linear-array echoendoscopes with slow-pull/fanning technique. Tissue acquisition was done with 19- or 22-gauge biopsy needles. Samples were included in formalin without rapid on-site evaluation and submitted for histopathological processing. The final diagnosis was based on conclusive histology or absence of evidence of disease progression after follow-up at least 6 months. Results Twenty-nine patients (21 men), with a median age of 68 (IQR: 56–77), were included. EUS-FNB was technically feasible and the sample quality was adequate for full histological assessment in all patients (100 %). Sensitivity, specificity, positive and negative predictive values, and overall accuracy for diagnosis of malignancy were 95.5 %, 100 %, 100 %, 83.3 %, and 96.3 %, respectively. In patients with malignant disease, the samples obtained allowed detection of signs of deep layer infiltration (“histological staging”) in 17 of 21 cases (81 %). No adverse events were noted. Conclusions The EUS-FNB technique demonstrated excellent diagnostic performance and safety in the study of unexplained diffuse gastrointestinal wall thickening. Histological staging was obtained in a high percentage of samples.

EUS-guided fine needle aspiration provides an open view for duodenal obstruction caused by urothelial carcinoma: a case report

“…To overcome this limitation, EUS-fine needle biopsy (FNB) was developed. Recently, one study reported that EUS-fine needle biopsy (FNB) technique had excellent diagnostic performance and safety in the study of unexplained diffuse gastrointestinal wall thickening [ 1 ]. We, therefore, suggested EUS-FNA/FNB should be performed in cases with prior negative endoscopic biopsies for the diagnosis of unexplained thickening of the duodenum.…”

“…Gastrointestinal wall thickening could be mostly observed in the stomach, esophagus, and rectum [1]. A variety of pathologies, including both benign and malignant causes could lead to the thickening of the gastrointestinal tract [2,3].…”